Skip to main content

Advertisement

Log in

Clinical Characteristics, Demographics and Prognosis of Transient Left Ventricular Apical Ballooning Syndrome

  • Basic Research Contributions
  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Background: Transient left ventricular apical ballooning syndrome also called Tako-Tsubo cardiomyopathy is defined as a syndrome consisting of stress induced apical ballooning of the left ventricle and normal coronary arteries. The majority of the published reports are case reports or case series with a small number of patients. The goal of this study was to perform statistical analysis of reported cases and case series in the literature in order to study demographic, clinical characteristics and prognosis of this syndrome.

Method: A PubMed search of the terms transient left ventricular apical ballooning, Tako-Tsubo, takotsubo, and apical cardiomyopathy was conducted for this study. All reports that contained information about individual patients were included in the statistical analysis.

Results: The majority of the patients were women (93.5%). Asians were the largest group (57.2%) followed by Caucasians (40%). The presentations mimics an acute myocardial infarction. The most frequent presenting symptom was chest pain (65.9%) followed by dyspnea (16.2%). ST elevation was the most common ECG abnormality (87.5%). Contrary to most reports, this is not a benign disease with complications occurring in 18.9% and death in 3.2%. The most common complication was shock followed by left ventricular thrombus formation and congestive heart failure.

Conclusion: Apical ballooning syndrome occurs most commonly in women and is associated with high complication rate. There are significant differences in presenting symptoms between race and gender which warrant further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dote K, Sato H, Tateishi H, et al. Myocardial stunning due to simultaneous multivessel coronary spasm: A review of 5 cases. J Cardiol 1991;21:203–214.

    CAS  PubMed  Google Scholar 

  2. Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: First series in white patients. Heart 2003;89(9):1027–1031.

    Article  CAS  PubMed  Google Scholar 

  3. Marcu CB, Andresen KM, Donohue TJ. Transient apical ballooning of the left ventricle. Med J Aust 2004;181(10):572.

    PubMed  Google Scholar 

  4. Ibanez B, Navarro F, Farre J, et al. A, Cordoba M. Tako-tsubo syndrome associated with a long course of the left anterior descending coronary artery along the apical diaphragmatic surface of the left ventricle. Rev Esp Cardiol 2004;57(3):209–216.

  5. Lupi G. Transient ballooning of the left ventricle: A case report. Ital Heart J 2004;5(8):635–637.

    PubMed  Google Scholar 

  6. Osherov A, Matetzky S, Beinart R, et al. Transient left ventricular apical ballooning (Tako-tsubo): The syndrome that mimics acute myocardial infarction. Isr Med Assoc J 2004;6(9):550–552.

    PubMed  Google Scholar 

  7. Glockner D, Dissmann M, Behrens S. Atypical acute myocardial ischemia syndrome with reversible left ventricular (LV) wall motion abnormalities (“apical ballooning”) without significant coronary artery disease. Z Kardiol 2004;93(2):156–161.

    CAS  PubMed  Google Scholar 

  8. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352(6):539–548.

    Article  CAS  PubMed  Google Scholar 

  9. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111(4):472–479.

    Article  PubMed  Google Scholar 

  10. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004;94(3):343– 346.

    Article  PubMed  Google Scholar 

  11. Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: A novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002;143(3):448–455.

    Article  PubMed  Google Scholar 

  12. Fritz J, Wittstein IS, Lima JA, et al. Transient left ventricular apical ballooning: magnetic resonance imaging evaluation. J Comput Assist Tomogr 2005;29(1):34–36.

    Article  PubMed  Google Scholar 

  13. Nishikawa S, Ito K, Adachi Y, et al. Ampulla (‘takotsubo’) cardiomyopathy of both ventricles: Evaluation of microcirculation disturbance using 99mTc-tetrofosmin myocardial single photon emission computed tomography and doppler guide wire. Circ J 2004;68(11):1076–1080

    Article  PubMed  Google Scholar 

  14. Ito K, Sugihara H, Katoh S, et al. Nakagawa M. Assessment of takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT–comparison with acute coronary syndrome. Ann Nucl Med 2003;17(2):115–122.

    Google Scholar 

  15. Kawabata M, Kubo I, Suzuki K, et al. Tako-tsubo cardiomyopathy' associated with syndrome malin: Reversible left ventricular dysfunction. Circ J 2003;67(8):721–724.

    Article  PubMed  Google Scholar 

  16. Kyuma M, Tsuchihashi K, Shinshi Y, et al. Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): Three cases. Circ J 2002;66(12):1181– 1184.

    Article  PubMed  Google Scholar 

  17. Kurisu S, Inoue I, Kawagoe T, et al. Left ventricular apical thrombus formation in a patient with suspected tako-tsubo-like left ventricular dysfunction. Circ J 2003;67(6):556–558.

    Article  PubMed  Google Scholar 

  18. Witzke C, Lowe HC, Waldman H, et al. Images in cardiovascular medicine. Transient left ventricular apical ballooning. Circulation 2003;108(16):2014

    Article  CAS  PubMed  Google Scholar 

  19. Pison L, De Vusser P, Mullens W. Apical ballooning in relatives. Heart 2004;90(12):e67.

    Article  CAS  PubMed  Google Scholar 

  20. Nyui N, Yamanaka O, Nakayama R, et al. ‘Tako-Tsubo’ transient ventricular dysfunction: a case report Jpn Circ J 2000;64(9):715–719.

    Article  CAS  PubMed  Google Scholar 

  21. Connelly KA, MacIsaac AI, Jelinek VM. Stress, myocardial infarction, and the “tako-tsubo” phenomenon. Heart 2004;90(9):e52.

    Article  CAS  PubMed  Google Scholar 

  22. Peraira Moral JR, Segovia Cubero J, Oteo Dominguez JF, et al. A case of transient left ventricular apical ballooning with an unusual complication. Rev Esp Cardiol 2002;55(12):1328–1332.

    PubMed  Google Scholar 

  23. Barriales Villa R, Bilbao Quesada R, Iglesias Rio E, et al. Transient left ventricular apical ballooning without coronary stenoses syndrome: importance of the intraventricular pressure gradient. Rev Esp Cardiol 2004;57(1):85–88.

    Article  PubMed  Google Scholar 

  24. Gallego Page JC, Lafuente Gormaz C, Dominguez Rodriguez P, et al. Rudilla M, Fuentes Manso R, Aguilera Saldana M. Transient ventricular dysfunction after emotional stress. Rev Esp Cardiol 2004;57(11):1124–1127.

    Google Scholar 

  25. Miyazaki S, Kamiishi T, Hosokawa N, et al. Reversible left ventricular dysfunction “takotsubo” cardiomyopathy associated with hyperthyroidism. Jpn Heart J 2004;45(5):889–894.

    Article  PubMed  Google Scholar 

  26. Yasuga Y, Inoue M, Takeda Y, et al. Tako-tsubo-like transient left ventricular dysfunction with apical thrombus formation: a case report. J Cardiol 2004;43(2):75–80.

    PubMed  Google Scholar 

  27. Matsuoka K, Nakayama S, Okubo S, et al. Transient cerebral ischemic attack induced by transient left ventricular apical ballooning. Eur J Intern Med 2004;15(6):393–395.

    PubMed  Google Scholar 

  28. Sasaki N, Kinugawa T, Yamawaki M, et al. Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction. Circ J 2004;68(11):1081–1083.

    Article  PubMed  Google Scholar 

  29. Amaya K, Shirai T, Kodama T, et al. Ampulla cardiomyopathy with delayed recovery of microvascular stunning: A case report J Cardiol. 2003;42(4):183–188.

    PubMed  Google Scholar 

  30. Kai R, Yasu T, Fujii M, et al. Apical ballooning by transient left ventricular dysfunction (so-called “ampulla” cardiomyopathy) associated with therapy for acute pulmonary thromboembolism: a case report. J Cardiol 2001;38(1):41–46

    CAS  PubMed  Google Scholar 

  31. Ishikawa K. “Takotsubo” cardiomyopathy A syndrome characterized by transient left ventricular apical ballooning that mimics the shape of a bottle used for trapping octopus in Japan. Intern Med 2004;43(4):275–276.

    Article  PubMed  Google Scholar 

  32. Ueyama T, Hano T, Kasamatsu K, et al. Estrogren attenuates the emotional stress-induced cardiac responses in the animal model of Tako-tsubo. J Cardiovascular Pharmacol 2003;42 Suppl.

  33. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 2001;38:11–18.

    Article  CAS  PubMed  Google Scholar 

  34. Abe Y, Kondo M, Matsuoka R, et al. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol 2003;41:737–742.

    Article  PubMed  Google Scholar 

  35. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I. Angina pectoris-myocardial infarction investigations in japan. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina pectoris-myocardial infarction investigations in Japan. J Am Coll Cardiol 2001;38(1):11–18.

    Article  CAS  PubMed  Google Scholar 

  36. Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005;128(1):296–302.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mohammad-Reza Movahed MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Donohue, D., Movahed, MR. Clinical Characteristics, Demographics and Prognosis of Transient Left Ventricular Apical Ballooning Syndrome. Heart Fail Rev 10, 311–316 (2005). https://doi.org/10.1007/s10741-005-8555-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-005-8555-8

Key Words

Navigation